What you need to know about pelvic organ prolapse

Do you need to wear a pad when you exercise? Do you find it hard to make it to the toilet on time? You might be at the onset of developing some form of pelvic organ prolapse (POP). And you could be making it worse by doing everyday things like lifting children or going for a run. Don't ignore it. Here's what you need to know...

What is pelvic organ prolapse?

POP starts with a weakening of the pelvic floor muscles causing any one or more of the pelvic organs to shift out of position into the vaginal canal. There are five different types of POP - a prolapse of the bladder (cystocele), of the intestines (enterocele), of the rectum (rectocele), of the uterus (uterine) and of the vagina (vaginal vault).

It is estimated that in the Western world one in four women – of every age and every demographic - suffer from some form of POP, states the Association for Pelvic Organ Prolapse Support (APOPS). This figure increases to one in two in women over 50 years of age, states the Royal College of Obstetricians and Gynaecologists.

What are the causes of POP?

The first main cause of POP is vaginal childbirth. Complicated labours such as forceps deliveries or multiple childbirths can cause immediate impact, although symptoms might not show up until many years later. The second main cause is the menopause. Due to the drop is oestrogen levels during the menopause, the pelvic floor muscle tissue doesn't work as effective any longer.

Other causes of POP include chronic constipation and chronic coughing. However, every day activities like heavy lifting (not only work-related lifting, but also the simple lifting of children) and 'pounding' exercise such as running and aerobics can cause POP. Plus there is a genetics factor to take into account, too. And if you suffer from a neuromuscular disease like MS, there is a higher chance that you'll develop POP.

Women suffering from POP most likely have more than one of the above mentioned risk factors. But beware, it is also possible for women who have never given birth to develop POP.

What are the most common symptoms of POP?

The most common symptom of POP is urinary incontinence. Other debilitating symptoms that women can suffer from are faecal incontinence, coital incontinence, urine retention and chronic constipation. Women also report a constant painful pressure in the vagina, the rectum or in both.

POP can cause back and pelvic pain and can lead to a lack of sexual sensation and painful intercourse.

If POP is that common, how come I'm not familiar with it?

One word: embarrassment. Many women suffer from one of more symptoms of POP in silence, as they're ashamed or frightened to talk about it. They might even avoid daily activities such as walking, socialising, playing with their children so as not to get 'caught out'.

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As Sherrie Palm, Founder and Executive Director of the Association for Pelvic Organ Prolapse Support says:

"POP impacts women physically, emotionally, socially, sexually, in fitness activities and in employment. It is estimated to impact half the female population and has been on medical record for nearly 4000 years. However, the world continues to turn a blind eye simply because symptoms are embarrassing."

When women do pluck up the courage to talk about it, it's often to their GP. But because POP as a condition has not been medically mapped and no significant research has been done on it, there is no clear pathway for GPs to follow. Women might be offered incontinence pads, pessaries or laxatives, which might make every day life slightly more comfortable, but they don't tackle the actual prolapse. There's also little recognition of the mental impact it might bring.

What complicates matters is that there is no medical specialism that covers the entire pelvic muscle. Separate specialists cover colon rectal problems, gynaecological problems and bladder problems. Equally there can also be problems with diagnosis. As one sufferer explains: "I was treated for 12 months for Irritable Bowel Syndrome (IBS) and chronic constipation before I was finally diagnosed with a sigmoidocele [a rare type of POP]."

The best thing for GPs to do is to undertake a thorough pelvic exam every time a woman presents with any symptoms that could be related to POP. In an ideal world, a routine screening protocol for POP should be part of the exam.

Can POP be treated?

Yes it can, but the treatment is not always effective. As POP is often not diagnosed until it's in an established or advanced stage, women are left with no choice but to seek aggressive treatment in the form of surgery. Surgical treatment differs depending on the type and severity of the prolapse. Most surgery consists of the placement of a mesh (also called a sling) to support the prolapse. However, the use of mesh is controversial and not adequately regulated, and crucially only successful in 60-70% of operations.

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Unfortunately even a successful operation can lead to complications. If you have had an operation to repair a prolapse , your risk of developing a subsequent prolapse is increased. Also the surgical mesh can erode and disintegrate into the body, leading to potential nerve problems and possible autoimmune disease. According to APOPS, one third of women who choose to have surgery end up having multiple surgeries.

Are there any alternatives to surgery?

Pelvic floor exercises will strengthen the muscles and retrain them to be more effective in supporting the pelvic organs, making the symptoms of prolapse less bothersome. These exercises can be done as part of a physiotherapy treatment and are also part of most yoga and pilates practices.

Some women have also reported improvement of symptoms through alternative therapies such as acupuncture and reflexology.

Can I do anything to prevent developing POP?

Exercise that pelvic floor! This is something every woman should do on a daily basis anyway. The earlier you start, the better (so don't wait until you're pregnant or have had children). The pelvic floor is like a pair of pants which keeps the entire pelvic region together. Try and keep those pants nice and tight! If you find it hard to do these exercises, there are devices out there that can assist you.

Don't ignore any symptoms that might be the onset of POP, even if the symptoms don't give you any particular grief at the moment. If in doubt, see your GP, mention POP and ask for a thorough pelvic exam.

Laetitia TempelmanLaetitia is a PR manager for a creative agency and a freelance journalist.

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